Biomedical subjects
Publications and source records attributed to M Butterwegge.
Rare haemorrhagic disorders cause a lot of diagnostic and therapeutic problems to the obstetrician. By means of a pregnancy course and a birth process a report is given on the physiological drop of the factor XIII serum concentration and its difficult clinical interpretation. This paper presents pathophysiology, symptoms, complications and treatment of factor XIII deficiency in pregnancy.
The particulars of 78 patients with fetal demise of the last 14 years were evaluated retrospectively. The most important reason of fetal death was hypoxaemia or anoxaemia. 31 patients were delivered by cesarean section or had spontaneous uterine contractions. Induction of 47 abortions were started with oxytocin or prostaglandins. Within 12 hours 54% of the oxytocin and 67% of the prostaglandin group succeeded in spontaneous delivery. In both groups there were 5 management failure of therapy, so that alternative medication or a cesarean section lead to delivery.
A rare case of a struma ovarii and carcinoid of the ovary is presented. In comparison with 21 reported cases, the tumor was unilateral and showed no metastatic spread. The treatment of this primary ovarian tumor with low malignant potential, was bilateral salpingo-oophorectomy and hysterectomy. Long-term follow up is advisable.
This case report describes the diagnosis, treatment as well as maternal and fetal outcome of a pregnancy complicated by peripartum cardiomyopathy (PPCM). The article demonstrates criteria that define peripartum cardiomyopathy using clinical and echocardiographic features. In absence of preexisting heart disease an acute left ventricular dysfunction of the mother led to fetal bradycardia and immediate delivery. We discuss possible causes, clinical management and long term outcome in respect of the available literature. Future pregnancies should be avoided with at least 50 % risk of recurrence.
BACKGROUND: The development of a new technique to evaluate the normal fetal acid-base balance in risk deliveries with pathological fetal heart rate has been seen with great expectations over the last years. The aim of this representative survey was to ask for the actual status of the fetal pulse oximetry in clinical use in German delivery rooms and to analyze hopes, expectations and system errors. PATIENTS RESPECTIVELY AND METHODS: Collecting data were done by a representative, time limited anonymous questionnaire in all German clinics who used Nellcors fetal pulse oximetry N-400 in measuring fetal arterial saturation in the years 1995 - 1999 during risk deliveries with non-reassuring fetal heart rate. RESULTS: With 66,6 % of the departments participating a number of 54 clinics returned the questionnaires. An average of 4.5 times per month fetal pulse oximetry was used per clinic and in over 90 % of all cases the handling and fixation of the sensor was without problems. There is qualified staff in every clinic and regarding the satisfaction with this system an average note of 2.8 was assigned. Fetal pulse oximetry will be established in some years to replace fetal blood analysis and to reduce operative deliveries. Technical problems in cases of insufficient sensor fixation at the fetal head and with the re-sterilization of fetal sensors must be solved in the future. CONCLUSIONS: Fetal pulse oximetry will be incorporated as the third method of monitoring the fetus during labor.
Pulse oximetry has triggered a revolutionary change in monitoring patients in many branches of medicine. For 4 years fetal sensors with specially calibrated pulse oximeters are tested clinically. Additional examination methods are required for accurate monitoring the fetus intrapartum because of the low specificity of cardiotocographs and also to avoid unnecessary operative deliveries. Research on hand up to now has demonstrated that fetal pulse oximetry is a method easy to learn, easily applicable and well quanitifiable to improve fetal monitoring and the interpretation of the fetal heart rate patterns intrapartum. Prospective intervention studies involving management studies still have to prove the clinical value of this new technology. Only after examining a large number of hypoxic-risk fetuses we can assess whether pulse oximetry in a management can replace invasive fetal blood analysis as a continuous, non-invasive method of monitoring. Various teams try to prove a context between arterial saturation values (SpO2) and biochemical changes of the fetus in connection with a crucial limiting value of 30% by correlating changes of the fetal scalp with the oxygen saturation. Guidelines for the assessment of the SpO2-values are established according to the present level of knowledge and future aspects of the method are examined.
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Reflectance pulse oximetry is a new method to monitor the fetus during labour in order to get a better assessment of the fetus's condition than by CTG interpretation alone. In this study the method is investigated with regard to its prognostic value concerning fetal outcome and complications possibly due to its application: Increased uterine bleeding, umbilical cord complications, amniotic infection syndrome. Arterial oxygen saturation was continuously recorded during labour in a total of 122 patients with a gestational age between 37 and 42 weeks and correlated to the umbilical cord-pH post partum and, if available, to intrapartum fetal blood gas analysis. 30% seems to be a threshold value below which oxygen saturation should not drop for a longer period of time. A post partum pH < 7.2 can be expected in more than 50% of the cases in which the saturation remains below this value for more than ten minutes. The application of the fetal pulse oximeter sensor did not affect maternal or fetal morbidity.
156 mothers and their newborns (Group A), whose deliveries were monitored using cardiotocography and fetal pulse oximetry, were investigated during and after delivery regarding amnioninfection as well as changes in morbidity und compared to matched controls (Group B). The parameters observed were temperature during labor and delivery and after delivery, infection parameters of mother and baby, bacterial smears of the vagina before placement of the oximetry sensor and smears of the sensor tip when the evaluation was concluded. An amnioninfection syndrome was registered twice in group A and three times in control group B. In 22 cases the evaluation of the smears showed an increase of bacterial growth or additional bacteria, but in no case an amnioninfection syndrome was noted. Three of the newborns in Group A who had an infection after delivery showed negative bacterial smears from the sensor tip. The temperatures of the mothers during and after delivery in Group A were not significantly different from Group B. The results show that the intrauterine application of a sensor even for longer periods of time does not result in an increase of maternal or fetal infection morbidity during labor and delivery and after delivery. In addition, 65 patients were evaluated with an anonymous questionnaire after delivery regarding their acceptance of this new method. 88% of the patients were satisfied with the procedure and stated that they felt an additional sense of security through this supplementary method.
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